County caseworkers and nurses assess each individual for his/her CDPAP eligibility.

To be eligible for CDPAP, an individual must:

Be Medicaid eligibile;

Be eligible for home care services, personal care services, or private duty nursing;

Require some or total assistance with one or more home care, personal care, or skilled nursing service;

Have a stable medical condition; and

Be self-directing or have a designated representative who is willing and competent to assume the roles and responsibilities that go with the program.

The definition of a self-directing consumer is:

“a consumer who is capable of making choices regarding the consumer’s activities of daily living and the type, quality and management of his or her consumer directed personal assistance; understands the impact of these choices; and assumes responsibility for the results of these choices.” (10 NYCRR 505.28(b)(9))

Since the consumer assumes employer responsibilities, (to recruit, hire, train, supervise and terminate) s/he must be capable off performing these duties. Directing the personal assistant and completing required paperwork are core competencies.

Differences Between CDPAP and “Traditional” Health Care

Traditional home care programs have what are called “levels.” There are certain tasks that a “homemaker” may provide, others that a “personal care aide” can provide, others a “home health aide” can provide, others a “Licensed Practical Nurse” or “Registered Nurse” can provide. CDPAP, on the other hand, has one level of employee - the personal assistant (PA).

What makes the two programs very different are:

1) who selects the PA;2) who trains the PA and how the PA is trained;3) who supervises the PA;4) who schedules the PA;5) how the tasks are done;6) who terminates the PA (if the employment relationship isn’t working.)

Since you, the consumer, assume employer responsibilities, (to recruit, hire, train, supervise and terminate) the rules shift a bit. Instead of a nurse from an agency, you are the one who is directing your “Plan of Care” that was developed by the county caseworker and nurse who performed your program assessment. Your authorized hours are based on this plan and it is your county caseworker determines how many hours can be paid, per week, to personal assistants who you must find (recruit) and hire.

What makes CDPAP different from traditional models of home care is that you are legally able to train your personal assistant to do tasks that a nurse would otherwise have to do. This is possible because: 1) you are training and supervising the personal assistant to perform a task in the way that you want it done, 2) there is an amendment to the Nurse Practice Act that legally allows anyone to perform tasks that typically only a nurse would be allowed to do, such as administer medications, because you are training and supervising the personal assistant (PA). NOTE: During your initial (and ongoing) county assessment(s), a Registered Nurse will work with you to determine whether or not you are confident that you can train and supervise personal assistants to assist you with “higher level” tasks.

You will work with a CDPAP organization, known as a fiscal intermediary (FI), who will provide administrative support for you. The FI works to facilitate processes such as: collecting paperwork, payroll, benefits and supporting consumers to navigate directing their program.

The fiscal intermediary members of the Consumer Directed Personal Assistance Association of New York State (CDPAANYS) strive for the best check and balance model while affording consumers the highest level of empowerment, consistent with the original philosophy of CDPAP.

Once you have been approved the county will refer your case to a FI. Once the FI receives the referral the company will contact you!

What If You Don’t Agree With the Department of Social Services?

If you were denied participation in the Consumer Directed Personal Assistance Program or you disagree with a caseworker’s decision regarding your amount of authorized hours, etc., you have a legal right torequest a Fair Hearing. A Fair Hearing is a legal meeting between an Administrative Law Judge, the county and you (& any representatives for your case.)

Whenever the county makes a change to your authorization, the county caseworker must send you a Notice of Decision containing the details of the change(s). This document should have a case number and the phone number for the Fair Hearing office.

For more information on Fair Hearings go to the New York State Office of Temporary and Disability Assistance, Office of Administrative Hearings’ website:

You can also request a formal case conference with your County Department of Social Services. You may be able to resolve your differences and as a result, withdraw your Fair Hearing request at any time. Keep in mind that you cannot request Aid Continuing with a formal case conference – see the Will I Continue to Receive My Benefits While I Am Waiting for My Hearing? On the web site for more information.